13 July 2016
An Office of the Inspector General (OIG) audit of grants in Zimbabwe found that implementation arrangements and internal controls over the use of grants funds were generally effective. However, the auditors found areas for improvement, notably in the quality of health service provided to patients and the supply chain management system affecting the distribution of medicines in the country.
The OIG found that controls over financial risks were generally adequate in ensuring the economic, efficient and effective use of grant funds. At the time of the audit, the United Nations Development Program, the Principal Recipient of Global Fund grants, had reported savings of US$27 million from the procurement of anti-retrovirals thanks to unit costs and volume discounts. However, some gaps remain in implementers’ financial controls, which impact the effective use and accountability of grant funds. The OIG identified non-compliant costs amounting to US$0.4 million, as well as gaps in the management of advances, resulting in 40% of advances outstanding for over 120 days.
Despite substantial economic challenges, Zimbabwe has successfully scaled up interventions to fight AIDS, tuberculosis and malaria in the past two years with support from the Global Fund and other development partners. This is demonstrated by a 30% increase in the number of people on antiretrovirals in 2014 and 2015, almost universal diagnosis of malaria cases before treatment and an increase in tuberculosis treatment success from 79% in 2014 to 83% in 2015.
However, the OIG found that this scale up has not always been accompanied by corresponding increases in the quality of services, especially for HIV and malaria. Contrary to national guidelines, 13% of the 30 facilities visited by the OIG (accounting for 32% of HIV positive cases in facilities visited) did not consistently carry out confirmatory tests to mitigate against the risk of false HIV diagnoses. The National Malaria Control Program’s data indicate that 40% of 179 malaria outbreaks were detected on time but the response was late. These outbreaks accounted for 20% of malaria related deaths. Grant funds have been subsequently identified to support the implementation of an emergency response plan.
Most Global Fund grant funds are spent on the procurement, storage and distribution of health commodities (approximately 68% across the three diseases). Since the last OIG audit in 2012, the country’s supply chain management system has seen improved assurance arrangements, more capacity and better management of expired medicines. However, notwithstanding these improvements, challenges remain. For example, there are multiple and fragmented distribution systems (although they are in the process of being replaced with a single system). Supplies of anti-malaria medicines to health facilities are irregular leading to under or overstocking and expiries of medicines. The OIG also identified stock differences amounting to US$2.0 million at facility level due to inadequate record keeping.
With the help of its partners, the Global Fund Secretariat is putting in place corrective actions to address the issues highlighted in the OIG report including developing plans to improve quality of service and supply chain management. The Secretariat will also review the funds that cannot be accounted for and make proposals for potential recoveries.
The Global Fund has disbursed US$930 million to Zimbabwe to date. There are currently 840,000 people on antiretroviral treatment, 62,000 tuberculosis cases are being treated and 4,890,000 insecticide-treated nets have been distributed to protect against malaria.
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The Office of the Inspector General safeguards the assets, investments, reputation and sustainability of the Global Fund by ensuring that it takes the right action to defeat AIDS, tuberculosis and malaria. Through audits, investigations and consultancy work, it promotes good practice, reduces risk and reports fully and transparently on abuse.
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